Mycophenolate Mofetil Use Is Associated With Reduced Incidence of Food Allergy in Liver Transplanted Children

Abstract

Objectives: Nonalcoholic fatty liver disease (NAFLD) is the leading chronic liver disease in youth, yet little is known about the adolescent patient's experience with NAFLD, which is key for treatment engagement. We examined adolescents' experiences with NAFLD diagnosis, thoughts on how NAFLD affects their daily life, understanding and perceptions of diagnosis and treatment, and impressions of how to improve care. Methods: Utilizing a mixed-method design, adolescents with NAFLD (N = 16; Mean age = 15.8 years; Mean BMI = 37 kg/m 2 ) participated in focus groups. To supplement qualitative data, adolescents and their caregiver completed measures assessing illness perceptions, adolescent quality of life, and eating/activity behaviors. Results: Focus group themes suggested reactions to diagnosis varied from unconcerned to anxious. NAFLD diagnosis occurred within the context of other psychological/medical concerns and was not perceived to affect most adolescents' daily lives. Although adolescents understood general contributors to NAFLD, comprehension of their diagnosis varied. Adolescents were more likely to make lifestyle changes when families were supportive, and they preferred tailored recommendations for health behavior change from the healthcare team. Notably, 62.5% of adolescents were more concerned about their weight than NAFLD. Almost half (43.8%) identified as food insecure. Conclusions: Adolescents with NAFLD may benefit from personalized treatment. Care could be enhanced by ensuring comprehension of diagnosis, problem-solving personal, and family barriers and increasing fam-ily support. Harnessing adolescents' desire for weight loss may be a more salient driver for change in disease status. Interventions should also address systemic barriers such as food insecurity to ensure equitable care.

Late airway complications following pediatric liver transplantation: A case series

“…18 More recently, use of adjuvant MMF has been identified to have a potential role in attenuating development of post-transplant atopy, beyond its utility as a tacrolimus-sparing agent. 19 MMF, which is used routinely in renal transplant protocols, is a known suppressor of B-lymphocyte activity and IgE production. Decisions on tailoring immunosuppression to address de novo atopy need to be balanced against the risk of organ rejection.…”

“…Success with conversion of tacrolimus to sirolimus has been seen in a small retrospective case series 18 . More recently, use of adjuvant MMF has been identified to have a potential role in attenuating development of post‐transplant atopy, beyond its utility as a tacrolimus‐sparing agent 19 . MMF, which is used routinely in renal transplant protocols, is a known suppressor of B‐lymphocyte activity and IgE production.…”